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Community-acquired pneumonia as medical emergency: predictors of early deterioration
  1. Martin Kolditz1,
  2. Santiago Ewig2,
  3. Benjamin Klapdor2,
  4. Hartwig Schütte3,4,5,
  5. Johannes Winning6,
  6. Jan Rupp5,7,
  7. Norbert Suttorp3,5,
  8. Tobias Welte5,8,9,
  9. Gernot Rohde5,9,10
  10. on behalf of the CAPNETZ study group
  1. 1Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
  2. 2Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, EVK Herne and Augusta-Kranken-Anstalt Bochum, Bochum, Germany
  3. 3Department of Internal Medicine, Infectious Diseases and Pulmonary Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
  4. 4Department of Pulmonology, Klinikum Ernst von Bergmann, Potsdam, Germany
  5. 5CAPNETZ Stiftung, Hannover, Germany
  6. 6Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
  7. 7Division of Molecular and Clinical Infectious Diseases, Med. Clinic III, University of Lübeck, Lübeck, Germany
  8. 8Department of Respiratory Medicine, Medizinische Hochschule Hannover, Hannover, Germany
  9. 9Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
  10. 10Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
  1. Correspondence to Dr Martin Kolditz, Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Fetscherstr. 74, Dresden 01307, Germany; martin.kolditz{at}


Background Early organ dysfunction determines the prognosis of community-acquired pneumonia (CAP), and recognition of CAP as a medical emergency has been advocated.

Objective To characterise patients with ‘emergency CAP’ and evaluate predictors for very early organ failure or death.

Methods 3427 prospectively enrolled patients of the CAPNETZ cohort were included. Emergency CAP was defined as requirement for mechanical ventilation or vasopressor support (MV/VS) or death within 72 h and 7 days after hospital admission, respectively. To determine independent predictors, multivariate Cox regression was employed. The ATS/IDSA 2007 minor criteria were evaluated for prediction of emergency CAP in patients without immediate need of MV/VS.

Results 140 (4%) and 173 (5%) patients presented with emergency CAP within 3 and 7 days, respectively. Hospital mortality of patients presenting without immediate need of MV/VS was highest. Independent predictors of emergency CAP were the presence of focal chest signs, home oxygen therapy, multilobar infiltrates, altered mental status and altered vital signs (hypotension, raised respiratory or heart rate, hypothermia). The ATS/IDSA 2007 minor criteria showed a high sensitivity and negative predictive value, whereas the positive predictive value was low. Reduction to 6 minor criteria did not alter accuracy.

Conclusions Emergency CAP is a rare but prognostic relevant condition, mortality is highest in patients presenting without immediate need of MV/VS. Vital sign abnormalities and parameters indicating acute organ dysfunction are independent predictors, and the ATS/IDSA 2007 minor criteria show a high negative predictive value.

  • Pneumonia

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